New Study Looks Set to Reduce Harm for Older Patients

New Study Looks Set to
Reduce Harm for Older Patients Facing Heart Surgery

A
surprising finding from a major international study
involving hundreds of New Zealanders, looks set to reduce
major side effects including death among older patients
facing cardiac surgery, as well as conserve the use of a
precious and expensive resource … donated blood.

Published in the prestigious New England Journal of
Medicine, the study has shown that using lesser amounts of
transfused blood in older patients undergoing cardiac
surgery is not only just as safe, but actually safer than
using more liberal amounts.

One of the study’s lead
investigators, Auckland Hospital Intensive Care Specialist
Dr Shay McGuinness, says the new findings go against what,
until now, has been international accepted best practice for
surgical teams operating on older patients having open heart
surgery.

“Prior to this study it was accepted wisdom
that older patients need to be transfused to a higher
haemoglobin level because it was thought their body’s
physiology and ability to cope with the stresses of surgery
made them less able to tolerate lower levels than younger
patients” says Dr McGuinness.

“The results from this
new study, which follows patients six months after their
surgery, clearly show that using less transfused blood
during and after heart surgery actually lowers the
patient’s subsequent risk of heart attack, stroke, kidney
failure and death” he says.

The randomised study, the
world’s largest ever transfusion trial in cardiac surgery,
was carried out on over 5200 patients at 74 hospitals in 19
counties. It included more than 560 patients from Auckland
City, Waikato, Wellington, Christchurch and Dunedin
hospitals. New Zealand supplied the second highest number of
patients for the trial.

Some moderate-to-high risk heart
surgery patients were given a liberal blood transfusion
strategy while others were given a lesser, more restrictive
strategy. For every 28 patients aged 75 years or older
treated with a restricted blood transfusion strategy, one
patient was prevented from experiencing a major complication
up to six months post-surgery.

Study co-author Dr Paul
Young, from Wellington’s Medical Research Institute of New
Zealand (MRINZ) says these findings will change clinical
practice around the world in terms of when and how much
blood needs to be given during and after cardiac surgery.

“Not giving a blood transfusion until an older
patient’s haemoglobin measurement is as low as 65% of
normal, while once considered risky, now appears to be just
as safe if not safer than giving blood more liberally”
says Dr Young. “This means many who would have been
transfused in the past will no longer require it at all, and
patients who previously required several units of blood may
now only require one”.

Researchers say these results
have one other significant implication for the health
system….one with the potential to conserve a precious and
expensive resource.

“If these research findings are
adopted into every day practice then not only will they
result in better health outcomes for older patients but also
major savings for health systems in the use of less donated
blood for transfusion” says Dr McGuinness. “This is
important as cardiac surgery uses significant amounts of
donated blood in theatre”.

“As our population ages and we do
more and more cardiac surgery on a growing number of older
patients, a reduction in the use of blood may help to ease
the pressure on both donors and the blood service, where
donors are finding it difficult to make time to donate”
says Dr Charlewood.

The Health Research Council-backed
study is the very first completed by the New Zealand
Improving Outcomes After Cardiac Surgery Network – a new
programme within the Medical Research Institute of New
Zealand (MRINZ) which brings together cardiac surgeons,
anaesthetists, Intensive Care Specialists, nursing and
support staff.

“The next step now is to develop robust
guidelines to determine exactly when we should use
transfusions for older people having cardiac surgery” says
Dr
McGuinness.

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